Improving Fertility Care for Black Women & Reducing Barriers to Access

*Please note that in this article the use of the word “woman” refers to an individual with ovaries. 

As we continue to innovate in the field of reproductive medicine, one area of need that we’re hyper-aware of is improving access to care so that anyone who wants to build a family can safely do so. Today, there persist a number of fertility and reproductive health issues specifically related to Black individuals with ovaries and the care accessible to them on their family building journeys. Dr. Ijeoma Okeigwe, fertility specialist and Director of IVF and Preimplantation Genetics at Spring Fertility Oakland points out that “Black women experience infertility at a 1.5 to 2 times higher rate than white women. Black women are also 3–4x more likely to die from a pregnancy-related complication compared to white women.”

When we think about the main factors contributing to that disproportionate impact, Dr. Okeigwe says “There are both individual and systemic factors that contribute to these disparities. While we know that race is a social construct, there are certain conditions that do show a higher incidence among people from certain ancestral backgrounds. For example, people of African ancestry have a higher likelihood of developing fibroids and we know fibroids increase the risk of infertility. Maternal health conditions such as high blood pressure and heart disease may contribute to the higher rates of pregnancy-related deaths. Other critical contributing factors include social and systemic factors such as: inadequate access to care, delays in care, and systemic bias.”

While we know that location is a major factor for a couple or individual when choosing a fertility clinic at which to receive care, it’s important to understand that inadequate access to care refers to more than just whether or not there’s a clinic option within driving distance. Quality of care is of critical importance, especially when it comes to populations who have been historically underrepresented or misrepresented. Dr. Okeigwe points out that bias, whether implicit or conscious, is a barrier that negatively impacts Black women’s access to fertility care: “For example, one of the biggest misconceptions perpetuated for many decades was that Black women are hyper-fertile and don't experience infertility.” As medicine and technology continue to advance, Dr. Okeigwe flags the use of artificial intelligence as a development that must be handled delicately, for the safety of all patient populations: “Today as we think about the use of AI in healthcare, I think we have to be careful about how we use clinical algorithms to guide how we care for diverse populations. We need to ask ourselves: where is the data being generated from? Is the source representative? Is the data generalizable? Is this algorithm going to lessen or perpetuate disparities?”

We know that, when it comes to health equity, representation matters, yet a shockingly small percentage of OBGYNs in the United States identify as Black (about 10.7% in 2021), and that percentage is even smaller when you're talking about reproductive endocrinologists. Dr. Okeigwe shares “It's important for people to understand how history shapes how others experience the world. A lot of harms have been carried out against Black people by health care institutions and the government. For some, this historical context and/or their own personal experiences of racism have shaped their distrust of the health care system. With this context in mind, it can often be comforting to be cared for by a person who looks like you. There have been many studies that show that doctor-patient racial concordance, especially among Black patients, is associated with greater patient satisfaction, greater access and utilization of care, and a lower likelihood of postponing or delaying seeking care.” It can also be helpful to read patient reviews from individuals you identify with to understand the first-hand experience they had at a specific clinic or with a specific provider. When it comes to seeking care for prenatal, birth, postpartum, and pediatric support, the Irth App was created as a space for reviews specifically written by BIPOC women. 

When it comes to advocating for yourself and your reproductive healthcare, wherever you are on your fertility journey, Dr. Okeigwe offers the following advice: “The fertility journey is unlike any other journey in medicine. I think one of the best ways to advocate for yourself is to be honest with your doctor about your fears and concerns and ask questions. Sometimes you may not know what to ask, which is normal. In those cases, I think it can often be helpful for patients to simply say: ‘I don't know what questions I should ask. Are there common questions that others bring up that you can discuss with me?’ Other times, maybe it's just simply a matter of you asking for educational materials or resources that you can read through on your own time.”